Anomalous Right Hepatic Artery Coursing along the Gall Bladder: A Rare Finding in Laparoscopic Cholecystectomy

Abstract

Aims: Anatomical variations of the right hepatic artery (RHA) can create substantial risk during laparoscopic cholecystectomy (LC), particularly when an aberrant vessel lies close to the gallbladder and may be mistaken for the cystic artery. Careful attainment of the critical view of safety (CVS) and restrained use of energy devices before definitive identification of structures are important for avoiding vascular injury. Case Presentation: A 65-year-old female patient with a 6-month history of intermittent right hypochondrial pain was diagnosed with gallstone disease on ultrasonography and underwent LC. Minimal adhesions were present around the gallbladder and Calot’s triangle. During dissection, the cystic duct and a short cystic artery were identified and clipped. A separate vascular structure was observed coursing beneath the gallbladder peritoneum from the neck towards the fundus and entering the liver near the fundus. The vessel gave branches to the gallbladder and was identified intraoperatively as an anomalously coursing RHA. It was carefully dissected from the gallbladder wall and preserved, allowing completion of standard LC. A drain was removed on the second postoperative day, and the postoperative course was uneventful. Conclusion: This case documents an uncommon RHA course closely associated with the gallbladder wall. Careful dissection, attention to vessel calibre and course, and confirmation of anatomy before division of structures facilitated recognition and preservation of the vessel.